Wednesday, February 27, 2008

Ontario Liberals ignore Quebec's "profound" health-care changes

“A task force has proposed “profound” changes to Quebec's health care system, including a greater role for the private sector and a bigger contribution from taxpayers.

Among the working group's more radical proposals is that doctors be allowed under certain restrictions to practise in both the public and private systems and that private insurance companies be authorized to insure services currently covered under the public health program.The government should also allow private firms to manage hospitals by testing their efficiency through pilot projects that could eventually lead to “productive new options” according to the report.

The head of the task force, former Liberal minister and insurance company executive Claude Castonguay, said people are demanding changes to an “incoherent and rigid” system and should be given the freedom to choose the kind of health care services they want.”

A working group headed by the man known as the father of Quebec's medicare system is recommending that people pay every time they visit a doctor.

“People can choose what car they want to buy, what suit they want to wear, what house they want to live-in, but when it comes to their health, they don't have a choice. That's what I'm against,” Mr. Castonguay said in an interview Tuesday. “We are proposing to give a greater role to the private sector so that people can exercise a freedom of choice.”

“All good ideas are welcome,” Health Minister Philippe Couillard said Tuesday of the report by Mr. Castonguay, the man known as the father of Quebec's medicare system. But Mr. Couillard was quick to shoot down at least one proposal — that the Quebec sales tax be increased to finance a special health fund.

“We don't intend to raise the TVQ,” Mr. Couillard said, using the French-language acronym for the tax.

University of Toronto law professor Colleen Flood, scientific director at the Canadian Institute of Health Research and an expert on public-private health care financing, said she was surprised the task force would go as far as to recommend that doctors be allowed to practice in both the public and private health care systems.

“In my view that is the sort of irrevocable step towards a two-tier health care system,” Ms. Flood said in an interview Tuesday. “Once physicians are able to work in the private system then you will start to see the real flourishing of that private system. Doctors will have a financial incentive to spend more time in the privately financed system … and there is already a concern that there aren't enough doctors in the public system.”

A similar dissenting view was expressed by task force member Michel Venne, who nonetheless supported many of the report's other recommendations.

The task force proposes the creation of a “health stabilization fund” financed by up to a 1-per-cent increase in the provincial sales tax.

Funding would also come from a maximum 1 per cent to 2 per cent deductible based on income and the number of times a person uses the health care system.

The new funding scheme would collect slightly more than $2-billion and would be used to curb the projected 5.8-per cent growth in government spending for health care to 3.9-per cent.

Health costs currently makes-up 44-per cent of the total provincial budget.

Another cost for patients would involve charging a maximum $100 “annual contribution” to become part of a health clinic and obtain access to a family doctor and other services. Statistics show that one in every four Quebec residents does not have access to a family doctor. The measure would act as an incentive for doctors to take-in new patients and give all Quebeckers access to a family doctor within five years.

The task force insisted that the recommendations comply with the spirit of the Canada health Act but urged the federal government to change the law which “hampers the evolution of the provincial health systems.”

The report argued that the Canada Health Act was too restrictive and failed to meet the increasing need for more private sector involvement in the health care system.

Hospital budgets should also be set differently to make health care institutions more efficient. The task force proposes that hospital budgets be determined by the services they provide to patients creating a financial incentive to treats patients adequately. “The money would follow the patients,” Mr. Castonguay explained. “Patients would no longer be viewed as an expense but rather as a source of revenue for hospitals.”

The report also responded to the needs of the province's aging population. It recommended that the government focus on improving home care services and that medical, nursing and certain specialized care be universally covered by the public system. However the tax credit offered to cover the cost of home care should be subject to a means test according tom income.”

*Are McGuinty’s Liberals listening to and watching what Quebec is doing on the health-care front ??

Castonguay’s report is certainly profoundly and boldly different than anything any Canadian politician has said regarding health care in decades; maybe even since Tommy Douglas.

Ontario Liberal health minister George Smitherman once crowed: “For years, we have been shadow-boxing with often obscure voices agitating for two-tier healthcare” (Ottawa Citizen, Sept.11, 2006) Well: now in Feb. of 2008, will Smitherman or any of his Liberals be ‘shadow boxing’ with Castonguay??

It’s astounding that several years ago when Alberta’s Ralph Klein proposed mild, almost benign “third-way” changes to his province’s health system, Liberals across the country were castigating Klein.

Wrote the Toronto Star (Apr.2, 2006):

“McGuinty's ablest political pit-bull, Health Minister George Smitherman, attacked Klein's "third way" scheme for greater private- sector involvement in health care as "getting pretty close to two- tier.""Our government firmly believes in a single-payer, universally accessible health-care system, where the breadth of your wallet is not a determinant in whether you're getting more timely or higher quality access to health-care services" said Smitherman last July.”

So where are the Liberals today who’re castigating Castonguay? What, is Smitherman letting Flood do his PR?

Bradley and his Liberals are stubbornly years behind Quebec in awareness of the severity of Ontario's health-monopoly problems.

Ontarians will be forced to suffer in health-care limbo as Ontario's Liberals wait for the McCreith/Holmes charter challenge against Ontario's health-monopoly to wind its way through the courts. Maybe only then will Jim Bradley and his Liberals be prompted to change their monopolistic ways, as Quebecers, (post-Chaoulli) have realized they must do.